The pelvic floor muscles are a group of muscles that support the organs in the pelvis and allow for bowel movement, urinary activity and intercourse function. During pregnancy, pelvic floor function can be compromised leading to pain, incontinence, sexual difficulties or general pelvic floor dysfunction. Prenatal and/or postnatal exercise can reduce the occurrence of symptoms, and these same exercises can help anyone suffering from pelvic floor difficulties, pregnancy related or not.
Both as prevention and as a remedy, we often suggest kegel exercises when dealing with pelvic floor complications and as a personal trainer that specializes in prenatal & postnatal fitness, I sometimes do the same. But pelvic floor issues are specific to the individual; if incontinence and/or some kinds of pain is the main problem, then some light muscle strengthening is appropriate but certain pelvic floor difficulties require just the opposite. Sometimes, urinary urgency can be paired with pain, incomplete emptying, hesitancy, or a stop-start stream. Also, constipation, pain during intercourse and back and pelvic floor pain can be signs that your pelvic muscles are too too tight. In this case we need to learn relaxation techniques, and take a look at posture and lower back strength. When speaking with any kind of therapist or trainer, be specific with your symptoms and regardless of whether or not you need strengthening techniques ask about relaxation exercises too.
A few of my clients have hesitated to tell me about some of their issues related to pelvic floor dysfunction, but its nothing to be embarrassed about. Your body has just gone through a massive change and while it may have already been months since you delivered the baby, it doesn’t mean everything will return to its right place and normal function. It’s so common and luckily enough it is normally, quite easily fixed!
When I run through pelvic floor exercises with my clients there are a few things I try to emphasize:
1. Include exercises in different positions (including standing)
Kegels or pelvic floor exercises are often taught lying down or sitting, but the pelvic floor muscles are used constantly during all positions. Also, incontinence often occurs while standing or while in transition from one position to the next. It is important to get used to strengthening these muscles in as many real life positions as possible.
2. Include movement in most if not all of the exercises
As mentioned above, we often experience incontinence while in transition of body position or while in motion. The pelvic floor muscles are not .meant to function in isolation, they work in tandem with other muscles, even when simply sitting and trying not to pee. Just like working any other muscle of the body, it is much more effective and functional to train it in movement rather than in isolation (which is impossible anyways!)
3. Do not match breathing with the movements but rather let the trainee breathe “through” it naturally
In many core exercises for mobility and stability I discourage matching the breath with the movement of the exercise. This may seem counter intuitive, especially if you have experience in yoga or pilates where the timing of the breath is often practiced.
In our daily movements, as our core muscles, including the pelvic floor and glutes, work together, our tendency is to breathe through movements (unless they are weight bearing). Mimicking free breathing through these exercises as we would during normal daily motion is a good way to build reflexive movement. Pelvic floor exercises are very low impact and do not require additional weight or complicated movement and so any necessary bracing can be done without holding the breath or exhaling during exertion.
4. Always include relaxation techniques
As mentioned above, an overly tight pelvic floor can restrict regular bodily functions and cause pain or discomfort. Our goal is not just to build strength but to create elasticity and a stronger mind/body connection to promote a greater ability to control these deep muscles. Focusing on the muscles used during exercises while trying to relax them and the surround muscles will help build the control you need for a healthy pelvic floor. Sometimes switching your position can help to. So if the exercise was performed on your back, you can try lying on your stomach during the relaxation phase.
1. Knee Drop – Lay on your back with your knees bent and feet flat on the floor. The movement is a slow, lateral knee drop, one lag at a time. Before you begin to lower your knee, create a light ‘brace’ by drawing in your belly just slightly. This should lightly activate your Transversus abdominis muscle which will allow you to hold the natural arch in your lower back during the movement but still allow for easy breathing. Now draw in/up your anterior pelvic floor muscle (pee muscle) and begin the movement. The knee drop should be done very slowly. You should be able to perform 1 repetition on both sides before relaxing. Take a couple of deep breaths and focus on relaxing all the muscles you were using. Repeat 5-10x each side
2. Sit & Stand – Stand in front of a chair or stability ball (placed in a corner). The movement will be a slow sitting and then standing motion. You will want to complete the sitting motion, i.e. let all of your weight rest on the chair or ball before returning to the standing position. Before you sit, draw in/up your pelvic floor muscle, lean forward slightly keeping your back straight and lower your weight to the chair. Keep your pelvic floor activated and return to a standing position by leaning forward again and pushing up through your heels. Relax the pelvic floor between repetitions and take a minute to sit or lay down and go over your relaxation techniques.
In my opinion, pelvic floor exercises should be limited to between 10-15 minutes per day, including a few minutes of relaxation techniques. It doesn’t take long for these exercises to work as long as you are fairly consistent with them. But like any kind of exercises, give yourself some off days to recover and relax completely. Remember, these muscles are in play all day long with almost every movement you make, so they are being used, you just want to increase your awareness and elasticity (mobility and stability).